- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $10.05 / $13.27 / $23.80
| Facility | 26 | $10.05 | $13.27 | $23.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.26 / $39.46 / $73.45
| Professional | | $32.26 | $39.46 | $73.45 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $8.84 / $10.19 / $16.98
| Professional | 26 | $8.84 | $10.19 | $16.98 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $23.29 / $28.56 / $53.05
| Professional | TC | $23.29 | $28.56 | $53.05 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.82 / $11.82 / $11.82
| Facility | 26 | $11.82 | $11.82 | $11.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.01 / $46.29 / $76.05
| Professional | | $35.01 | $46.29 | $76.05 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.15 / $14.17 / $20.96
| Professional | 26 | $10.15 | $14.17 | $20.96 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.17 / $34.29 / $55.20
| Professional | TC | $24.17 | $34.29 | $55.20 |
- Facility/Professional
- Facility
- Modifier
- 26
- Low / Median / High Price
- $11.95 / $11.95 / $11.95
| Facility | 26 | $11.95 | $11.95 | $11.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.74 / $50.56 / $85.14
| Professional | | $34.74 | $50.56 | $85.14 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $9.63 / $14.98 / $24.05
| Professional | 26 | $9.63 | $14.98 | $24.05 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.88 / $35.65 / $63.19
| Professional | TC | $24.88 | $35.65 | $63.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.50 / $44.35 / $76.80
| Professional | | $35.50 | $44.35 | $76.80 |
- Facility/Professional
- Professional
- Modifier
- 26
- Low / Median / High Price
- $10.19 / $12.70 / $22.47
| Professional | 26 | $10.19 | $12.70 | $22.47 |
- Facility/Professional
- Professional
- Modifier
- TC
- Low / Median / High Price
- $24.77 / $30.44 / $54.40
| Professional | TC | $24.77 | $30.44 | $54.40 |